Certified Registered Nurse Anesthetists (CRNA) Week runs this week from January 21 to 27 and is an excellent opportunity for student nurses to find out more about this path in a nursing career.
With more than 52,000 nurse anesthetists and student nurse anesthetists, the career is thriving and attractive for several reasons. Many nurse anesthetists say the patient interaction they have is unsurpassed. They are with patients before, during, and after surgery, so there’s a necessary trust that is quickly established with the skill and care of the nurse.
Nursing students who are considering this as a career have many resources they can reference and various organizations that will help them succeed on this career path. The American Association of Nurse Anesthetists (AANA) is especially aware of promoting health and wellness among the student nurses who seek a career in this branch of nursing. The AANA’s 2017 report Wellness and Thriving in a Student Registered Nurse Anesthetist Population explored the significance of the relationship between student wellness and how well students do in their academic program.
To celebrate CRNA Week, Minority Nurse recently posed some questions to Michael Neft, DNP, MHA, CRNA, FNAP, FAAN, and assistant director of the Nurse Anesthesia Program University of Pittsburgh School of Nursing and nursing student Sara Wilkinson, BSN, RN, CCRN SRNA at University of Tennessee Health Sciences Center. The following are their answers.
Why is the AANA particularly aware of the health and wellness among student nurses looking to enter or actively studying in this field?
Student nurses are the future of the profession, and it is important to cultivate and prepare for a long and healthy career. Students who aspire to enter into nurse anesthesia programs must be healthy mentally and physically. They must have healthy outlets for stress relief, and healthy lifestyle habits that will support them throughout our educational programs.
Nurse anesthesia education programs are required by their accreditation standards to provide education content on wellness and substance use disorder. The AANA actively encourages members, students, as well as educational programs to engage whenever possible in healthy behaviors, whether that includes physical activity or simply reducing stress by encouraging individuals to take time for their loved ones or to engage in an activity they love.
The AANA is committed to providing resources and information about ways to become involved in establishing a healthy lifestyle and even offers fun runs, wellness tutorials and a massage therapy area at many of their conferences.
How does establishing good health and wellness practices now help a student nurse become better? And how will taking care of oneself now carry over once they graduate and are several years into a CRNA career?
Nursing has unique stressors like dealing with patient care situations that require critical thinking, fast decision making, and autonomy is tough. If the student nurse does not have the ability to cope with these situations autonomously, it is very difficult to care for patients. Maintaining both mental and physical health and wellness are at the foundation of successful practice.
Developing healthy lifestyle habits early, helps students handle stress more effectively, set clear goals, and develop a clear plan to achieve them. They also assist students with discipline, good study habits, prepare for clinical experiences properly, and self-evaluate objectively. It also helps to establish diet and exercise plans that can be adjusted as one transitions to practice, to avoid elimination of healthy habits out of inconvenience.
Maintaining a school-life balance is also important to develop a support system and find time for small, pleasant breaks to gives a fresh perspective and recharge. Establishing healthy behaviors and habits early is vital to long-term health, wellness, and maintenance of a successful career.
Do you have any advice for student nurses about considering this field and being aware of any challenges unique to this branch of nursing?
For student nurses considering the field of nurse anesthesia, awareness about the depth and breadth of study is valuable, but is important to be well, so that an individual will have the endurance to graduate. A strong support system and personal discipline are necessary to allow for healthy stress relief and appropriate professional conduct. Anesthesia remains the field with the highest incidence of drug abuse and unhealthy coping behaviors, due to high stress and access.
Think about what you do when stressed. Review your lifestyle habits: exercise, eating, alcohol use, and other substance use. Some prospective students may want to employ a lifestyle coach who can look at a person individually and help one to develop positive lifestyle habits that will set one up for success in graduate school and a stressful career. Good study habits, a healthy respect for one’s self and career, use of study resources, and strong, supportive relationships will be required to succeed and thrive in this field.
When nurses think of the big responsibilities in their careers, patient safety is predominant. But communication skills? Those aren’t often at the top of the list.
Nurses train for years to ensure the safety of their patients. Their unwavering advocacy for patients has done nothing less than transform healthcare. But patient safety can’t happen without clear communication skills. Nurses must have excellent communication skills to provide the best care for patients and to earn the respect of their peers.
What kinds of communication skills will nurses use? Here is just a small sample of how nurses use various communications skills throughout the day:
- Communicating with healthcare team members on a patient’s condition, diagnosis, treatment, complications, progress
- Explaining to patients about self care, about their diagnosis and prognosis, about resources, and about everything from medications to diet and exercise
- Talking with family and loved ones about patient needs, follow-up care, disease, recovery, medication
- Communicating with professionals in non-healthcare fields to help secure grants, influence policy, or explain a professional need
- Educating the public on healthcare issues that are important to their age, region, or personal health, or educating students on nursing practices or nursing career options
How can you improve your communication skills? Here are a few pointers:
- Be precise and clear. If you need information or you need someone to do something, say so. If you are giving information, present it in basic terms.
- Ask if anyone has questions. Your audience could be a roomful of academics at a conference, a team of colleagues in your unit, or a single patient—always ask if anyone has follow-up questions. Don’t assume that your audience heard and understood everything you said. This last step gives you an opportunity to recognize where your communication can be strengthened and to convey the needed information.
- Write clearly. Whether you are writing a memo or a research paper, use fewer words and make them have greater impact. Decide what you are trying to say, use short paragraphs for ease, add bullet points to emphasize your main points, and make sure you reread everything before you send it..
- Consider your tone and body language. The way you speak and hold yourself can support your words and intent, but if they are out of whack, your unspoken actions can cause confusion. Make sure you speak in even tones when possible and that your body language is approachable.
- Learn about best practices. You’ll find books, seminars, presentations, and even casual discussions that can all help you sharpen your skills. If you’re a nurse manager, bring this up in each employee review and ask for it in turn from your own supervisor.
Communication can always be improved. Each time it is, your capability as a nurse is strengthened.
As the demand for educated and qualified nurses continues to grow, prospective nursing students might wonder how they can afford nursing school now to open their career possibilities over a lifetime.
If you have applied to schools and are receiving acceptances and award letters, it’s time to crunch the numbers to figure out the best choice for your money. Schools offer many awards including merit scholarships, grants based on merit or need, and loans that fall into many categories. You can also make some other adjustments to shave off some costs without impacting your education.
How do you know you can afford nursing school? Here are some questions to ask.
Will You Be a Full-time or Part-time Student?
Some colleges and universities award scholarships based on the student’s academic load. If you are trying to decide which route is for you, check with the schools to see if there is substantially more money available that could impact your choice. Consider your employment potential as well. Part-time status takes longer to complete, but you may be able to work and go to school (and your employer might pay for part of your education).
Where Will You Live?
Living on campus generally costs more money. Attending a college that’s closer to home lets you save thousands of dollars on campus housing and meal plan fees. If you are already living at home, you’ll save by continuing to live at home and commuting to school.
Can You Take a Hybrid Route?
Are there any online courses that cost less? If you are aiming for a BSN, could you take a prerequisite class and some of your basic classes at a cost-saving community college and then transfer to a four-year college to finish your degree?
What Aid Is Available?
A strong academic record and solid application will likely land you some merit scholarship funding. Like a grant, that’s money the school gives to you. You don’t have to pay it back, but you do need to find out if the award will be renewed each year you are at the school. If you apply to a four-year college, you need to know you can afford all four years.
How Much Debt Are You Willing to Take On?
After any merit or need-based scholarships and grants, you can be awarded loans. Loans always have to be paid back. Federal loans come from the government and while they have to be paid back, they often have low interest rates, and you don’t start repayment until after graduation. If federal loans don’t meet your entire need, you can apply for private loans, which have higher interest rates and varying repayment policies.
What Are Your Post-graduation Plans?
Some nurses can have some student debt forgiven if they apply for and fulfill the requirements of the NURSE Corps Loan Repayment Program. In addition, some states offer specific loan repayment or forgiveness plans for nurses.
Figuring out how to afford nursing school is going to be different for each student, but there are many options and choices available. For many students, finding the right balance just takes some investigating.
As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.
Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.
In 2017, BMC Medical Ethics published a systematic review assessing a decade’s worth of publications for implicit bias in health care professionals. The conclusions stated a need for additional reviews and more homogeneous methodologies, but determined that implicit bias exists in health care settings and impacts quality and equity of care. Authors Mahzarin Banaji and Anthony Greenwald address the issue in books like Blindspot: Hidden Biases of Good People, as does Augstus White, III, MD, in Seeing Patients: Unconscious Bias in Health Care.
Here’s how to pay attention and fix it.
Notice Your Assumptions
Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.
Understand What Assumptions Trigger in You
You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?
Know Why It Matters
An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.
Know Your Patient
Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.
Talk About It
You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.
Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.
Planting the health policy seed has become increasingly important to professional nursing organizations, nurse educators, and even nursing students who applaud the call for integrating health policy and advocacy content in today’s nursing curricula. As nursing students become acquainted with the policymaking process, they are also encouraged to familiarize themselves with the various professional and specialty nursing organizations who advocate on behalf of the nursing profession and the patients/consumers they serve.
Numerous nursing organizations including the American Nurses Association (ANA), National Council State Boards of Nursing (NCSBN), and National League for Nursing (NLN), to name a few, work to ensure that nursing’s voice is represented during policy discussions on issues that impact health care delivery, patient outcomes, nursing workforce development, and other issues of concern to the profession. These and other organizations advocate to ensure that students have financial support to attend nursing school, have access to loan repayment programs, and support to advance their nursing education and training. These organizations work diligently to help ensure that today’s nursing workforce is well prepared to meet the demands of providing high-quality health care services in an ever-changing complex and challenging health care environment.
In this article, we present information about the American Association of Colleges of Nursing (AACN) and share insights from AACN Chief Policy Officer Suzanne Miyamoto, PhD, FAAN, RN.
The American Association of Colleges of Nursing
Since 1969, AACN has been a leader in advancing nursing education, research, and faculty practice. Moreover, AACN serves as a national voice for baccalaureate and graduate nursing education. In addition to creating standards for designing and delivering quality nursing education programs, AACN represents over 810-member schools and colleges of nursing nationwide. The AACN has a Government Affairs Committee and a Health Policy Advisory Council that coordinate and spearhead several public policy initiatives and activities focused on advancing nursing education, research, and faculty practice. Currently, the association’s federal policy agenda focuses on four key areas: workforce, higher education, research, and models of care—all ongoing public policy imperatives.
Here, Miyamoto shares some insights about her organization and health policy advocacy.
Describe Your Role and the Role of the AACN in Preparing Today’s Nursing Students in Becoming Influential Advocates in the Health Policy Arena.
As Chief Policy Officer, I oversee AACN’s policy and advocacy work at the federal level working with all three branches of government. My role and that of our team can be described as strategist, lobbyist, and analyst. To ensure we meet the needs of our member organizations, the association has a Government Affairs Committee and Health Policy Advisory Council that provides guidance when we are reviewing legislative proposals or federal regulations. We want to ensure that what we support, oppose, or remain neutral on is in line with the experiences or challenges of our member institutions. AACN is in a unique position that we represent the schools of nursing, which includes the deans, faculty, and students. This requires our advocacy work to be nimble and abreast of the key issues Congress and the Administration are discussing. It is our role to not only develop the strategy but to educate and inform our membership on our position and why we take it. Information is the best offense and the best defense. That is why AACN fully supports all members of a nursing school to be engaged in our advocacy efforts. We have a grassroots network with other 11,000 students, faculty, and deans. This network has great potential to grow and offers real-time, advocacy opportunities.
What Are Some Top Priority Policy Issues Impacting the Profession and Health Care Today?
Some key issues impacting the profession today include
• Securing funding for Nursing Workforce Development Programs, Title VIII of the Public Health Service Act, National Institute of Nursing Research, National Health Service Corps, among others
• The Title VIII Nursing Workforce Reauthorization Act (H.R. 959, S. 1109)
• Health reform
• Deferred Action for Childhood Arrivals (DACA)
• Public Service Loan Forgiveness
• Opioid epidemic
What Can Students Do Within Their Area of Influence to Advocate for the Profession?
It is important that students stay informed of the issues. Students need to be active participants in their own learning. To understand what is happening at the federal level, a student must embrace the policy from multiple lens. It is not enough to read one source or one disciple. To truly garner the depth and breadth of the issue, the more voices, for and against, the better one’s understanding becomes. Securing a basic level of knowledge on an issue that may impact one’s education, research, or future practice is an excellent starting point.
Grassroots campaigns are central to any of our efforts. We can be more effective if we know how our national organizations are weighing in on issues. It’s also important to listen to all perspectives. Again, policy think tanks like the Center for American Progress or the Heritage Foundation may have different political viewpoints, but on some issues, they may see eye to eye. Their rationale for getting there may be different, but it is that difference that can help further an argument depending on the audience. Students can also join forces with faculty and others to reach out to legislators at the federal, state, and local level on issues important to nursing. Discussing issues with nursing faculty, who can serve as tremendous mentors for those interested in policy, can ignite a passion for this work in the future. That is how I came to seek a career in health policy and advocacy. It was the foresight of my faculty mentors who gave me the opportunities to succeed.
What Resources Are Available for Nursing Faculty Who Are Preparing the Next Generation of Health Policy Activists?
AACN established a Faculty Policy Think Tank that worked to prepare a set of recommendations for AACN’s Board of Directors on this exact question. The charge of the group was to inform and improve the state of health policy education in undergraduate and graduate education. The ultimate goal was to consider ways that will help create a generation of future nurses who understand the micro and macro drivers that impact policy—most importantly, how nurses in the future can continue to skillfully insert nursing expertise into policy discussions. The report was released in October 2017.
Turning to the continued need for policy advocacy at the student level, AACN also offers a three-day student policy summit open to undergraduate and graduate nursing students enrolled at AACN member institutions. The program helps to prepare students to engage in policy advocacy and the federal policymaking process. For more information, visit http://www.aacnnursing.org/Policy-Advocacy/Get-Involved/Student-Policy-Summit.
As mentioned earlier, AACN’s 2017–2018 Federal Policy Agenda is well suited to serve as a foundation for shaping policy discussions during online and classroom discussions as well as during virtual and/or actual lobby days. Students are encouraged to speak with their deans and faculty at their nursing programs to learn more about what’s happening within their institutions regarding public policy advocacy efforts that impact nursing education and nursing practice.
Seeking Federal Support for Nursing Workforce Development Programs: A Clarion Call for Continued Advocacy
Very central to this discussion is the need for ongoing advocacy to secure funding to support Title VIII programs. Title VIII programs are administered under the U.S. Department of Health and Human Services, Health Resources and Services Administration. The Nursing Workforce Development Program (Title VIII of the Public Health Service Act) continues to benefit countless numbers of nursing programs, practicing nurses, faculty, students, patients, and communities. In fact, numerous minority nurses continue to benefit from diversity grants because of Title VIII funding. During 2015–2016, the Nursing Workforce Diversity grants supported 7,337 students. Numerous other minority nurses, including minority nurse faculty, have received funding through this program to support their advanced nursing education or pay back student loans. To learn more about how Title VIII programs are making a difference for nursing students, practicing nurses, academic institutions, and communities at large, visit http://www.aacnnursing.org/Policy-Advocacy/Title-VIII-Community-Impact.
As a nursing student, speak with your faculty and professional organizations about how you can play a role in policy advocacy. Throughout nursing’s history, nurses have made a tremendous impact in advancing the profession and the delivery of health care by advocating for issues of importance to them. Developing your knowledge base about these and other issues impacting the profession is a great first step to becoming an influential advocate on behalf of the profession and the patients and communities you serve.
After four years of rigorous schoolwork while working as a full-time assistant professor, I was physically and mentally spent when I started writing my doctoral dissertation. But despite this unimaginable exhaustion, I felt inspired, empowered, and euphoric because now, I could see the light at the end of the tunnel. I was almost at the completion of something I had worked so hard to accomplish. It took me almost a year to complete my dissertation while working overseas in Okinawa, Japan. I remember how writing the last chapter of my dissertation was the most challenging, as I was getting more impatient just to present and defend my research. Throughout this entire experience, I found my positive self-talk helpful each time I found myself unmotivated to get going: “Just try to write, even if it is just for a few minutes.” So, that was what I did.
I struggled with this dissertation at the worst time of my life. I was just about to start my dissertation when my mother’s health began to deteriorate. Almost three decades ago, I left my family in the Philippines, the people who had given me everything to be where I am today, to move to America. I felt obligated to take care of my mother. To be closer to her, I decided to take an overseas job and move temporarily to Okinawa, Japan. However, her condition turned worse, and she finally passed away after months of being in a vegetative state. To say that I was in a state of turmoil is an understatement.
My parents never graduated from college, but they understood the value of education. They worked very hard to support us and never asked us to help them. For them, our only job was to go to school and obtain a college degree someday. My doctorate was my greatest tribute to my mother’s sacrifices for her children’s education, but she did not live long enough to see it. My grief made me temporarily lose my motivation. Grief is a very uncomfortable place to be stuck. It is so easy to get trapped in that paralyzing sadness. Many times, I had to convince myself not to give up: “Give it a go because you’ve come this far. Don’t give up.” This self-talk served me well when I almost lost all my will and determination to complete my dissertation. With the help of my family and academic advisors, I was able to deal with my sadness my way to be able to move on. Their understanding and patience allowed me to feel, say, and think whatever it was I needed to heal. In the end, my dissertation saved me and gave me back my focus.
The road to success is not easy to navigate, even for the most talented people. Would I have predicted that my life would turn out this way three decades after my husband and I moved to America? No. I came from a rural area in Cebu, Philippines, a typical small town devoid of big city luxuries. I was shy as a child because I felt so insignificant. My past is consequential to who I am today. To remember my humble beginnings is important to me. My roots made me who I am today.
When I started my doctoral program, I was extremely excited but was also very intimidated. I felt intensely inferior to the other students because they all seemed smarter and better educated than I was. With English as my second language, academic writing did not come easy. My insecurities and self-doubts were the driving forces that made me work harder. I probably studied twice as hard and wrote twice as long as everyone else. I worked harder and longer to compensate for my shortcomings. I still remember how I struggled during my first course and how frustrating it was when I accidentally erased my paper and had to write another one. My will and determination helped me to overcome my fear of failing. Writing my dissertation has been the most demanding, exhausting, yet highly rewarding endeavor in my life. It was a long and arduous journey not just for me but also for my husband and sons who had supported me throughout the process. From my experience, it is easy to get lost along the way, procrastinate, and give in to distractions. But with perseverance and hard work, the finish line is attainable.
I will always remember what my father taught me to help me overcome my inferiority complex as a child: “The harder you work, the luckier you get.” My life would have been completely different if I took a different path 25 years ago. As a first-generation immigrant in the United States, I am proud that I have gotten this far. Of course, there were many hardships and setbacks, but there were also many successes in my life. The little successes I had slowly built my confidence so that over time, I started to believe that I could dream big.
It has been a year since the conferral of my doctoral degree. It was a transformative process for me, a self-discovery experience of how much I could persevere to accomplish something I consider worthwhile. My graduation was a life-fulfilling moment for me—an accomplishment of a lifetime that I am so proud and grateful. The experience made me realize that I am more than I ever thought I was. It changed me. I came out stronger and better. Although it was largely an intellectual endeavor, the physical endurance to multitask and the emotional resilience to persevere when life-changing events happen were critical elements that made my dream a reality. Because I overcame my fears and shortcomings, I came out more hopeful of what the future brings.